Quantitative Detection of Quantitative Detection of Parkinson's Disease SymptomsParkinson's Disease Symptoms

Advisor: Advisor: Dr. Chris KaoDr. Chris Kao

Project Team:Project Team:Kylen BaresKylen BaresEddie CaoEddie Cao

Dr. Changquing (Chris) Kao, M.D., Dr. Changquing (Chris) Kao, M.D., Ph.D.Ph.D.

Research Associate Research Associate Professor in Department Professor in Department of Neurosurgery at of Neurosurgery at Vanderbilt University Vanderbilt University Clinical interest:Clinical interest:– Microelectrode brain mapping Microelectrode brain mapping

for target localization of deep for target localization of deep brain stimulation treatment of brain stimulation treatment of movement disordersmovement disorders

Research focus: Research focus: – Electrophysiology in nerve Electrophysiology in nerve

stimulation, epilepsy, pain stimulation, epilepsy, pain control and head injurycontrol and head injury

What is Parkinson’s Disease?What is Parkinson’s Disease?

Neurodegenerative disorder Neurodegenerative disorder caused by damaged or dead caused by damaged or dead dopamine-releasing neurons in dopamine-releasing neurons in the the substantia nigrasubstantia nigra Dopamine: neurotransmitter Dopamine: neurotransmitter that carries information from that carries information from neuron to neuron and neuron to neuron and eventually to the muscleseventually to the musclesBrain no longer able to direct Brain no longer able to direct or control muscle movement in or control muscle movement in a normal manner. a normal manner. Half a million people every Half a million people every year are affected by year are affected by Parkinson’sParkinson’s

SymptomsSymptoms

Tremor or trembling in hands, arms, legs, Tremor or trembling in hands, arms, legs, jaw, and face jaw, and face

Rigidity or stiffness of the limbs and trunk Rigidity or stiffness of the limbs and trunk

Slowness of motor movements Slowness of motor movements

Postural instability or impaired balance Postural instability or impaired balance and coordination and coordination

Reduction in blinking rate of eyesReduction in blinking rate of eyes

TreatmentTreatment

Drugs: Levodopa/ L-DopaDrugs: Levodopa/ L-DopaDrugs designed to mimic Drugs designed to mimic dopamine effects or dopamine effects or counteract acetylcholine counteract acetylcholine effectseffectsPallidotomy: Section of Pallidotomy: Section of globus pallidus removedglobus pallidus removedDeep Brain Stimulation Deep Brain Stimulation (DBS) : Implants (DBS) : Implants stimulators that block stimulators that block brain signals causing brain signals causing rigidity, tremors and other rigidity, tremors and other symptomssymptoms

http://www.pdmdcenter.com/articles/HopkinsWeb/index.htmlhttp://www.pdmdcenter.com/articles/HopkinsWeb/index.html

Deep Brain Stimulation

3 parts: lead electrode, extension wire, neurostimulatorLead electrode: thin, insulated wire inserted through the skull within the tip placed inside predetermined target area (located by MRI or CT scan)Extension: thin, insulated wire connecting lead and neurostimulator, passing under the skinNeurostimulator (NS): “battery” pack implanted under the skin near neck or torsoElectrical stimulation is delivered from NS to affected target area in the brain, blocking abnormal nerve signals

ProblemProblem

Quantifiable measurement of the Quantifiable measurement of the symptoms of Parkinson’s disease is symptoms of Parkinson’s disease is needed to maximize therapy.needed to maximize therapy.

Unfortunately, there currently does not Unfortunately, there currently does not exist a method known to be reliable.exist a method known to be reliable.

Our DeviceOur DeviceA pneumatic-actuated frame that fits around the right A pneumatic-actuated frame that fits around the right

armarm

- uses air pressure for individual flexion of the - uses air pressure for individual flexion of the fingers and forearmfingers and forearm

- measures the pressure exerted on the actuator - measures the pressure exerted on the actuator pistonpiston

- this pressure corresponds to the force needed to - this pressure corresponds to the force needed to move the arm and, therefore, the rigidity of the arm move the arm and, therefore, the rigidity of the arm musclesmuscles

Each patient will be their own control since we only Each patient will be their own control since we only need to measure effectiveness of treatmentneed to measure effectiveness of treatment

Our DeviceOur Device

Composed of two main partsComposed of two main parts– Control BoxControl Box

Contains the pneumatic valves and pressure Contains the pneumatic valves and pressure manifoldmanifold

– Arm frameArm frameEncloses the arm and translates motion of Encloses the arm and translates motion of pneumatic cylinders into motion of the armpneumatic cylinders into motion of the arm

Pneumatic Circuit Diagram

Current StatusCurrent Status

Acquired materials for control box and Acquired materials for control box and pneumatic actuators for arm framepneumatic actuators for arm frame

Control box is complete, pending a minor Control box is complete, pending a minor change in tube layout. change in tube layout.

Acquired access to a life-size dummy to Acquired access to a life-size dummy to design our frame arounddesign our frame around

ProE model has been completedProE model has been completed

Planning the construction of the prototypePlanning the construction of the prototype

Some answered questionsSome answered questions

Anesthesia does affect rigidity, but cannot Anesthesia does affect rigidity, but cannot be eliminated, so administration is be eliminated, so administration is localized.localized.

Some patients do have tremors, which, Some patients do have tremors, which, however, don’t affect the effectiveness of however, don’t affect the effectiveness of measurement.measurement.

Stimulation mapping will quantitatively Stimulation mapping will quantitatively detect efficacy more objectively about detect efficacy more objectively about muscle function improvement.muscle function improvement.

Ultimate GoalsUltimate Goals

To create and test the viability of a fully To create and test the viability of a fully controllable pneumatic device that forces controllable pneumatic device that forces movement in the arms of actual movement in the arms of actual Parkinson’s patients and accurately Parkinson’s patients and accurately displays the required pressure to induce displays the required pressure to induce movement.movement.

To enable the device to adjust in order to To enable the device to adjust in order to comfortably fit multiple patients.comfortably fit multiple patients.